Lub René, Denig Petra, van den Berg Paul B, Hoogenberg Klaas, de Jong-van den Berg Lolkje T W
Department of Clinical Pharmacology, University of Groningen, Groningen, The Netherlands.
Br J Clin Pharmacol. 2006 Dec;62(6):660-5. doi: 10.1111/j.1365-2125.2006.02711.x. Epub 2006 Jun 23.
The aim of this study was to investigate the impact of new insights and revised guidelines on initial and follow-up treatment with antihyperglycaemic drugs over the period 1998-2003.
The InterAction Database (IADB), which contains pharmacy dispensing data from 53 community pharmacies in the Northern and Eastern part of the Netherlands, was used in this study. Prevalence and incidence rates of oral antihyperglycaemic drug use were calculated for each year. Follow-up treatment was compared for two cohorts of initial users of oral antihyperglycaemic drugs, starting treatment either 1 year before or 1 year after guideline revision.
The prevalence and incidence rate of oral antihyperglycaemic drug use increased over the study period from 1.8% to 2.4% (P < 0.001) and 0.3% to 0.4% (P = 0.04). The proportion of metformin as initial treatment increased rapidly in the observation period from 14% to 50% (P < 0.001). Initial users of metformin in 2000 received additional treatment with a sulphonylurea in the follow-up period less often compared with those who started metformin in 1998 (46%vs. 60%, P < 0.004). In contrast, initial users of sulphonylurea in 2000 received additional treatment with metformin more often compared with those who started a sulphonylurea in 1998 (42%vs. 36%, P < 0.008). The new drugs, thiazolidinediones and meglitinides, were seldom used as initial treatment.
New insights and the revision of the practice guideline were followed by a significant increase in both initial and follow-up treatment with metformin among patients with Type 2 diabetes mellitus.
本研究旨在调查1998 - 2003年期间新见解和修订指南对降糖药物初始治疗及后续治疗的影响。
本研究使用了互动数据库（IADB），该数据库包含荷兰北部和东部53家社区药房的配药数据。计算每年口服降糖药物使用的患病率和发病率。比较了口服降糖药物初始使用者的两个队列的后续治疗情况，一组在指南修订前1年开始治疗，另一组在指南修订后1年开始治疗。
在研究期间，口服降糖药物使用的患病率和发病率从1.8%增至2.4%（P < 0.001），从0.3%增至0.4%（P = 0.04）。在观察期内，二甲双胍作为初始治疗的比例从14%迅速增至50%（P < 0.001）。与1998年开始使用二甲双胍的患者相比，2000年开始使用二甲双胍的初始使用者在后续治疗中接受磺脲类药物额外治疗的频率较低（46%对60%，P < 0.004）。相比之下，与1998年开始使用磺脲类药物的患者相比，2000年开始使用磺脲类药物的初始使用者接受二甲双胍额外治疗的频率更高（42%对36%，P < 0.008）。新型药物噻唑烷二酮类和格列奈类很少用作初始治疗。
新见解和实践指南的修订之后，2型糖尿病患者中二甲双胍的初始治疗和后续治疗均显著增加。
